Provider Demographics
NPI:1346795564
Name:CARROLL, WUANITA MARIA (MS)
Entity Type:Individual
Prefix:
First Name:WUANITA
Middle Name:MARIA
Last Name:CARROLL
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1212 N WASHINGTON ST STE 204
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99201-2401
Mailing Address - Country:US
Mailing Address - Phone:509-255-8722
Mailing Address - Fax:509-267-2717
Practice Address - Street 1:1212 N WASHINGTON ST STE 204
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99201-2401
Practice Address - Country:US
Practice Address - Phone:509-255-8722
Practice Address - Fax:509-267-2717
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-17
Last Update Date:2024-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health